Faced With A Broken Health Care System, Some Doctors Are Opting-Out

A combination of rising costs and low insurance reimbursements is forcing some primary care physicians to opt-out of the insurance game completely — accepting a flat fee instead of private insurance or Medicare. For a $4,500 annual fee, patients who formerly used their insurance to pay for doctor’s visits can get 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals. Or they can find another doctor.

From the Baltimore Sun:

Diana Moore learned the news through the neighborhood grapevine. Her family’s primary-care physician of seven years would no longer accept Moore, her husband and daughter as patients – unless the family paid a $4,500 annual fee.

The physicians at Charter Internal Medicine in Columbia are overhauling the practice, ditching the insurance-dependent model and instead charging a flat yearlyfee in exchange for the promise of 24-hour access to doctors, unhurried appointments, home visits and state-of-the-art annual physicals.

Known as “boutique” medicine or “concierge” care, the national trend appears to be sweeping across Maryland as primary-care doctors feel the financial crush of rising costs and low insurance reimbursement rates. Physicians say the model allows them to trim their patient loads and give patients quality care without worrying whether insurance will cover it.

“Primary-care doctors are seeing 30 to 40 patients a day – that’s too many,” said Dr. Harry A. Oken, who has been with Charter Internal Medicine for more than 20 years. “It’s not about the money. It’s about having the time to spend with your patients to keep them healthy.”

There’s already a shortage of primary care doctors, and they’re not as well compensated as specialists.

“Doctors have nowhere to turn but to try to find a different business model,” said Dr. Ronald Sroka, president of the medical society, known as MedChi. “Some people want more than their insurance company will provide, and some people are willing to pay for this additional service.”

Sroka, who practices in Crofton, said that after paying salaries and expenses, he makes about $15 to $20 an hour. He said he’s not sure if he can last more than another year or so, working some 80 hours a week to keep up with his bills.

For those of you thinking of finding a “boutique” doctor, keep in mind that you’ll still need insurance. Hospital stays, blood work and ambulance rides are not included.

@little stripes: Not exactly. They’re paying $4500 dollars for the family, but that means that they won’t be paying for office visits. They pay for tests and procedures, but they won’t have to pay the $50 to $250 per office visit.

Expect more of this if nationalized healthcare is on the horizon. Doctors can’t deny you emergency care, but they can tell you that their client list is full.

It isn’t any different than keeping an attorney on retainer. I spend about $1200 a year to keep our family lawyer on retainer. This puts me on his priority list, and if he has to bill me hours for something he takes it out of that retainer first.

@Erwos: Considering that you could drastically scale back the level of your insurance to cover catastrophic expenses this could financially viable for a lot of patients. My family pays a ton in premiums that we would save if we changed to a catastrophic policy.

@Erwos: The lab visits are covered by insurance, because it’s a different company.

However, what that’d mean is that the families going to see this doctor would have to pay this doctor $4,500 AND their regular health insurance premiums.

This may be a good deal for the doctor, and I don’t blame him for trying, but it’s most definitely NOT a good deal for vast majority of his patients…unless his patients are extra-ordinarily impatient and want his undivided attention whenever they want.

I would gladly pay the fee. My husband’s health coverage is free to us (he’s military) so the $4500 fee for a family doc would mean we’d have access to a doc 24/7 and still be covered for office visits. For us, it would be awesome.

@little stripes: $4,500, I wouldn’t say rich. The husband is military, they get discounts on some stuff, free health care (though you may be getting exactly what you’re paying for) and possibly very inexpensive to free places to live.

the $4500 may be what health insurance would cost them anyway if they had to pay.

@little stripes: I thought the same thing. YEESH. Do you think they take installments? That’s like $375 a month. Does the $4,500 cover the whole family or just one person? Would they take it out of your payrole, like they do insurance? So many questions.

@Vivelafat gags first, then covets.: The article above says the $4500 is for the whole family. That we could fit in if it came out of my pre-tax flex spending. I have kids that get sick like kids will do and I have a chronic, hereditary condition that must be carefully managed so I visit the doc more than most people. They aren’t urgent visits, just frequent med checks and monitoring so being able to get in and see the same doc every time (something that has never been possible at the base clinic) would be very appealing.

I know it wouldn’t work for every family and we’d have to research it a lot more before we signed on, but on the surface, it looks like something that would have real benefits for our particular situation.

@little stripes: I make $38k/yr AND go to a university part-time and I can afford it. That woman’s husband is in the military and deserves free healthcare based on that alone. I think you like to whine instead of adequately budgeting your money. Thankfully, you’re on the right site to learn how to do so. Pay off your credit cards and start pumping money into things such as healthcare instead!

@little stripes: Oh and just so you know… here’s a total of my bills off the top of my head… I paid a few thousand for last semester’s tuition (I think a few more thousand was covered by student loans… should have been about the same amount. So if I pay off those student loans at the same rate in which I pay the school once I get my degree, then that won’t be an issue.)… then I pay $500/mo rent, $100/mo electricity, $100/week food, $110/mo phone, $25/mo internet, $40-$50/week gasoline… that’s all I can think of off the top of my head. After healthcare and taxes and 401k contribution is taken out of my check, I make somewhere between $2300 and $2400 a month.

Now, I don’t have kids… but then again I am a firm believer that if you cannot AFFORD kids, then you’re not entitled to them. (Sounds pretty libertarian I suppose.)

@VA_White: 4500 is $375/mo. if you have kids or an elderly parent, having home visits can be a godsend.

We’re 27 & 30 y/o (no kids, non smokers) and we pay $500 for insurance (NJ), and that’s not including the portion paid for by my husbands work. we’re young and healthy – but we still have a $2500/deductible, and our health insurance is still crappy.

Admittedly, $4500/yr isnt for everyone. but you can likely pay it out of a HSA which is pretax $$, so you wouldve only seen $3,000 in your pocket if you spent it elsewhere.

i dont think i could get a Dr to my house for $250 ONE time, let alone ‘on call anytime’.

4500? I couldn’t afford that, and I doubt most others could as well. It’s tough enough saving for a home, a car, college – an added yearly expense, a considerable one at that, is over the line for me. I sympathize with the doctor’s getting jerked around by insurance companies, but there has to be some middle ground for affordable health care.

@AngrySicilian: Well, your doctor went through 4 years of college, 4 years of medical school, and 3 to 7 years of residency (depending on specialty), likely racking up incredible debt in the process — and then chose to be a family practitioner, one of the lowest-paid medical specialties in the country. It’s not like your doctor woke up one morning and won the lottery. Doctors bust their asses to get where they are.

Money certainly is a motivator for some of these doctors, but just as many of them are motivated by the desire to provide quality care. That simply isn’t possible when a doctor is expected to see 30+ patients a day, and the insurance companies either A) refuse to pay for needed treatment or B) incentivize overtreatment.

@AngrySicilian: I doubt you have ANY idea of how hard your doctor has worked all his life to be able to buy that Mercedes. That’s his reward for a lifetime of sacrifice and hard work, not to mention having to put up with bitchy whiny no-nothing patients like yourself. Liberals want socialized medicine – you WILL all suffer for their wants this time, believe me. Tell me in 20 year how well this socialist experiment has worked out for your and yours, mmm’kay?

@AngrySicilian: Last time I checked your job is about 1000 times less complicated.

Also at your job, if you make even a minor mistake are you possible going to lose not only your job, but your house and your car?

Also, how many years of schooling did you go through, did you have to go through a period where you were barely paid for the first year or two, do you have people calling you at all hours, how many hours a week do you work?

Also your confusing Primary Care with specialists. Most Primary Care docs have to be not only doctors, but business owners, and they barely get by. That’s why the number of Primary Care doctors is shrinking at an alarming rate.

But rather than look up any facts it’s easier to just make a sweeping generalization to make your self feel beter.

@El_Guapo: If you look around (ie, not your employer-based coverage) you can get catastrophic health insurance for a decent rate. Its hard to find, but its out there. Its typically about 40-60% of what you pay for full health insurance, so that savings goes to this care.

Even better, if you can find a high-deductible plan that offers HSA’s, go that way. The monthly premiums are usually pretty cheap, some employers do matching for contribution to your HSA’s, which could then be used to pay for medicine and incidentals.

But, sad to say, this is going to become more and more common if we keep this movement to governmental/socialized medicine. Those with means will always have a better access than those without.

Oh, and $4500 is $375 a month. Considering a family of 3, that’s not all that bad…

@Tux the Penguin: Except that you can’t get those sorts of cheap high-deductible plans at all (or if you can, they cost a ridiculous amount or have exclusions) if you have any sort of preexisting condition. And most of the aggregate healthcare dollars are spent on people who have chronic illnesses. So HSA plans are not a solution to our healthcare problems, because the only “insurance abuse” they discourage is frivolous minor use of the healthcare system by healthy people, and that just doesn’t account for most of the costs.

Is that $4,500 per “family” or per “person?” And if “family,” how many are counted in the “family?” If its per family (i.e. 4 people), that probably is the cost of most peoples’ insurance premium, but if its per person, that’s quite a bit more.

The thing I like about this idea is that one could hope it sends some message to the insurance companies about how little they reimburse the doctors for their services. If the insurance paid more, the doctors could take more patients.

A friend of mine has her kids on CHIP, but can’t find a local doctor who will see them because all the local doctors are “caped out” (i.e. already have the maximum number of children who are on CHIP as patients) and won’t accept any new patients on CHIP. So she has to drive nearly an hour to the nearest doctor.

@Tux the Penguin: But, sad to say, this is going to become more and more common if we keep this movement to governmental/socialized medicine. Those with means will always have a better access than those without.

Oh, and $4500 is $375 a month. Considering a family of 3, that’s not all that bad…

Those with means already have better access than those without. They have insurance and the ability to pay for what insurance doesn’t cover.

And depending on the family’s income level, another $375 a month can really hurt.

@El_Guapo: It’s certainly not cheap, especially since it doesn’t include hospital and emergency. If that’s the flat fee for a family, though, and there are kids with anything chronic that needs monitoring (even common stuff such as asthma or bad allergies), it may well be cheaper and more time-efficient than working standard insurance out of an HMO.

I’ve paid more out of pocket than that some years even with insurance, but it’s for stuff that this plan doesn’t cover. So for just me, it wouldn’t be worth it. But if I had three kids and no HMO access? It might be another story.

@El_Guapo: That is too much, I agree. There is a middle ground though, for a single, reasonably healthy person. I have a doc here (Martinsburg, WV) who charges $50-$125 per visit, depending on the services rendered (taking a blood sample? $50. Sitting with you for an hour, developing a comprehensive health strategy? $125). And you can still submit these visits for insurance, you just pay out of pocket first. It works really well for me.

Sounds tempting for those who have the cash. 375/mo for one person or 1500/mo for a family of four, assuming they do no incentives to get families in the door. This added to existing insurance fees.

I’m sure it will work for some affluent areas, but part of me cringes at how our current system seems to have created another sub-system that further screws over the people who can’t afford health care in the first place.

Also, it’s kind of funny how a health care business model is addressing the symptoms, not the cause.

Why can’t there be some middle ground? Unhurried appointments are nice but I don’t need 24hr access to a doctor and I don’t really need one to come to my house. It’s awesome that some are going back to house calls if some people need that but $4,500 is too much money to pay for a lot of care I don’t need and won’t use.

@Rectilinear Propagation: Yeah I’m young and fairly healthy. I have health insurance but don’t use it often. If I weren’t female and doing yearly exams and on BC, I might not even really need it (though I know I should have it).

@little stripes: Even a lot of older people don’t go to the doctor more than once or twice per month. If you go to the doc twice per month that’s 187.50 per visit. I understand there’s a lot of expenses to pay for, but the average person isn’t going to be in twice a month. I might go to the doctor 3 times per year, which means I’d be paying 1500.00 per visit.

@Rectilinear Propagation: Oh, you know, I think I meant to reply to this thread when I replied to El Guapo. In short, there is a pay-as-you-go cash only practice in my town…it’s $50-125 depending on services rendered, and it’s the most helpful docs around. You can also submit the bills to insurance yourself if you’re inclined to do so. Much better than going to a “participating” provider, which pretty much means they are participating in short-changing you, making you wait forever, and letting your health deteriorate because it’s cheap.

@sporesdeezeez:
I think the reason you pay for the entire year up front is so that the doctor can’t get out of providing your family with service. If you come down with something serious but common, like Pneumonia, you and your doctor are going to be seeing a LOT of each other – certainly more than $4500 worth. Also, I presume prescriptions are included with this plan. For some families, that makes the expense justifiable right there.

$4500? For health care? I could swear I heard a bunch of people a few weeks ago saying you could not get health care for under $5000. I think someone was proposing a $5000 tax credit to pay for health care and people said it was impossible.

@Git Em SteveDave loves this guy–>: @dtmoulton: You misread. The $4500 was for a family of three. Or at least that’s what the article implied. That would be $375 for all three, or $125 a person. Its probably $1500 a person for a year.

But, as I mentioned elsewhere, you wouldn’t need your traditional “full” insurance but something more akin to what your auto insurance is: “catastrophic” coverage. Or switch to a high deductible coverage with an HSA.

The health system as we have it now will not survive. Job-based coverage is one of the problems (if its such a great idea, lets tie ALL coverage to our jobs!). There are so many problems that need solving, but people aren’t willing to pony up to it (needless tests, overbilling, etc).

@Tux the Penguin: I don’t think this covers going to a specialist, an ob/gyn, etc. Only Primary Care. I would still need full regular health insurance. I’m from Baltimore and my primary care doc is moving to this model. He’s dropping me since I won’t pay the fee (for a single person it’s more like $2000). Now, I have to find another doctor.

@Git Em SteveDave loves this guy–>: Yep, it still is. This $4500 only gets you access to a PCP, which is the cheapest part of some people’s medical expenses. Doesn’t include drugs, specialist visits, tests, or hospital stays.

@polyeaster:
according to the full article:
“Rather, the doctors will charge patients $2,000 a year plus $500 for each child ages 14 to 25, a plan the practice calls the “Personalized Health Care Model.””

@TragedyAndy: The doctor really isn’t that accountable. I mean really, you prepay come down with something, and find your doctor no longer wants to deal with you, and just gives you a bunch of referrals. I see no recourse except next year getting a new doctor.

The real option would be a line of premium doctors, who actually accepted cash patients.

@erratapage: I was wondering about that too. I wonder if you could pay it from your HSA? If I did that it would meet my deductible for the whole year right off the bat. Then my PCP would be free for the whole year and since my deductible was met anything else would be greatly reduced or free.

Interesting. I wasn’t too sure about the whole idea at first but that would almost be worth it.

@tande04: I have to doubt this is an HSA allowed expense. The HSA model is still based on payment for services rendered, rather than a service contract. This sounds more like an HMO run by doctors for the benefit of doctors, and possibly patients.

I’d rather see a $2500 annual fee for normal office access, plus a limited number of emergency calls/house calls per year, and a fee schedule for exceeding the limit.

I had a professor in college argue that if you removed third party payers from the system, health care costs would decrease. It makes sense since many doctors, hospitals, etc incur higher costs to deal with the insurance companies and pass that on in terms of fees.

@Jesse: It’s absurd to think that the insurance paradigm can even work for healthcare. Insurance works by spreading a small amount of catastrophic risk over a large number of people – everybody who owns a home pays for house insurance, but the number of houses that burn down in a year is relatively small, so the catastrophic costs of a new house are split up among everybody – since nobody knows whose house is going to burn down (maybe yours!) everybody is fine paying a little bit.

But healthcare isn’t like that. You can’t share the risk because there is no risk – only the certainty that you’re going to need healthcare at some point, because everybody needs regular checkups, everybody gets sick, everybody gets injured, and if you live long enough everybody gets old.

Instead of splitting a small number of catastrophic events among a large number of people, health insurance tries to “split” everybody’s costs among everybody. The math doesn’t quite work out.

Is it any surprise, therefore, that it completely doesn’t fucking work, and therefore we have the worst, most wasteful healthcare system in the industrial world?

@Joeyjojo: I guess I have some hope in the upcoming Obama administration, I guess. Oh, I expect to be disappointed, but I can handle the disappointment of our reach exceeding our grasp. It’s been the steady disappointment of expecting too little perfidy from Republicans for the past 8 years that’s been hard to handle.

@Joeyjojo: Not to start a long Canada discussion, but the folks who have government only healthcare endure very long waits for services and decreased access to new medications to a degree that would have Americans fuming. As such, middle-class and above Canadians STILL buy private insurance plans to get preferrential treatment.

This is not insurance for under $5K. This is simply a fee to be a patient. You still pay for each visit, treatment, etc. It is possible, depending on the practice, that some charges may be lower, since they don’t have to cover the additional overhead insurance compliance requires.

It’s kind of like when you pay an entrance fee to live in a retirement community, but after the entrance fee, you still pay monthly rent.

One of the giant questions about healthcare reform that neither candidate is adressing is a magic wand is waived and all American’s have access to healthcare, exactly who will these 42 million newly insured go see?

You are right. I saw this before it is on top of what your insurance pays. Its so the pcp can dump all the medicaid or tenn care or medicare pats. It sucks and they suck. WE NEED FULL NATIONAL HELTH CARE NOW. And for all you free market folks it does’nt work for all people.

@frodo_35: Sounds good. But wont work. Hawaii recently had a state wide healthcare for kids. It lasted 7 months before the money dryed up. Medicare is failing, social security is failing. Our government is too corrupt for it to work.

Wow, way to selectively tell a story. What heppened in Hawaii is the state teamed up with a private benefits provider (HMSA which is effectively BCBS Hawaii) to administer a coverage program for uninsured children in the state (2,000 enrolled). The state was paying about $50K per month to HMSA to administer the program and provide coverage, however the Governor axed it recently due to the nearly $1Bn budget shortfall in Hawaii.

Universal healthcare can and does work. There is empirical evidence for this to be the case. The OECD does very detailes studies of healthcare spending on a per capita basis and as a percentage of GDP. The US blows away the rest of the OECD countries by a long shot. Additionally they compare measures of healthcare effectiveness such as death rates for particular causes and find the US gets average to below average results. For example the death rate for heart disease in the US is higher than for 17 of the 30 OECD countries despite the fact that the US performs invasive heart procedures with a much higher frequency than any other OECD nation (almost 3x more than average). Of course this rate of performance may be due to some factor that leads Americans to be predisposed to heart disease but a comprehensive healthcare policy would seek to find and adress those factors. We simply treat the symptom here.

Medical care is a service that is fraught with information asymmetries between the consumer and producer. If you think people got hoodwinked during the mortgage mess, please open your eyes to the con job that goes on in healthcare every day. Needless procedures, tests and a I want it now attitude push costs through the roof. A profit motivated middleman (the insurance companies) add another layer of misinformation and confusion. If you spent 2x as much on a car and got half the fuel economy, half the comfort and half the reliability of anything else on the market I can’t imagine you’d go back to that brand. Why should healthcare be any different?

One of the giant questions about healthcare reform that neither candidate is adressing is a magic wand is waived and all American’s have access to healthcare, exactly who will these 42 million newly insured go see?

@SkokieGuy: It’s depressing the way it doesn’t occur to any of the politicians that if the hospitals are overcrowded and the doctors over booked then maybe we should, I don’t know, get more hospitals and doctors.

We should be falling all over ourselves to help people who want to become doctors and nurses get through school. We need them too much to make it so impossible to accomplish financially.

The US does have fewer practicing physicians per capita than OECD average (2.4 per thousand vs. 3.0) but it’s not unsolvable. A larger problem is the disparity in acute care hospital beds (2.8 per thousand vs. 4.1 average) but this too is solvable, not insurmountable. One area we do lead in is diagnostic equipment (32.2 CT Scanners per Million vs. average of 18.8 and 26.6 MRI machines per Million vs. 8.8 average) so the money is there to train more doctors. Plus once you remove the idea of a luxury suite from a hospital you’d be surprised how many more beds you can get.

The other thing that would be extremely beneficial to ya know attract more doctors, is to limit the payday that is medical malpractice litigation. Insurance is incredibly expensive to begin with and if you get sued and lose it becomes a negative income proposition to keep practicing medicine as your insurance becomes unfathomably high. Imagine the disincentive that someone has to dedicate 8-10 years of their life studying a subject, incurr 300K+ of debt and know that it can be taken away with one honest mistake.

@Ass_Cobra: Malpractice paydays ain’t what they used to be — the insurance companies are still putting the doctors over a barrel, but not because the threat of a huge malpractice verdict is that high. Medical malpractice litigation already has been limited in a number of places, by capping the amount of damages a plaintiff can receive. Guess how much the insurance companies lowered their malpractice premiums as a result. (Hint: they didn’t, even though they campaigned for the legislation by promising that they would.)

Also, malpractice suits aren’t about “honest mistakes” — they require absolute tons of evidence and some level of fault (negligence) on the doctor’s part.

I think any business where you get nearly 60% of the recovery amount is pretty good. But I can understand your point that even with caps the insurance companies are not passing along the savings.

I guess my use of “honest mistake” should have been clarified. I mean it in the sense that many doctors feel that they are better off documenting what they are doing rather than focusing on patient care because they are treating every patient interaction as a walking lawsuit. Doctors aren’t willing to take good risks in patient care because any deviation from straight down the line protocols opens them up to being sued.

@Ass_Cobra: Speaking of another way the insurance companies are screwing doctors over, malpractice insurance rates are obscene. There aren’t that many big paydays. I’d like to see a system where if a malpractice company is required to pay a certain number of claims for major medical errors (resulting in permanent injury or death), they can file to have the doctor’s license revoked. The trade would be that they would be subject to a rate cap or other limitation. Then the bad doctors would be weeded out of the system, and the good doctors wouldn’t be forced to pay for their mistakes.

mmmmm…. I think that I’ll be staying with my company’s plan @ $20.00 per month for everything (health, dental, vision, long/short term disability, etc..) So, $240.00 a year sounds like a better deal for full coverage with a very low out of pocket responsibility.

It sounds like you have a job that you’ll never be able to quit with a plan like that!

To me, that seems to be the biggest frustration with our system. So many Americans are working really crappy jobs for no other reason than the health plan that is offered. This means employees can look for jobs based on the quality of the job, but the quality of the health care package. And it means that companies that can’t afford great insurance packages for their employees, aren’t necessarily getting the best candidates.

When the doctors get tired of insurance you know it’s time for a change.

I’ve read several stories like this over the last several years.

Personally I think the doctors want to much for basic office visits and the patient want a free visit for the sniffles-both have abused insurance on visits.

Unless you have to see a doctor every month you could save alot by having a major medical type coverage where you pay the doctors out of pocker per visit.

If the doctors knew they would be payed by the patient:a person and not an insurance company they would almost have to adjust their rates.

My favorite doctor(may he rest in peace) never accepted insurance of any kind but the most I ever paid for a visit was around 40$.He had no appointment office hours,a answering service would call him at home if you had a serious problem and he would refer to specialist if needed.

Now most doctors or practices figure the maximum payment from a particular insurance company and take it from there.

@u1itn0w2day:
Exactly. When you pay cash for visits, the doctor should give a discount. It’s how it works with every dentist I’ve ever used. The discounts can be quite large!

I think the reason it costs insurance companies so much isn’t because it’s some scam the office is running, it’s because insurance companies make it such a PITA to get money from them. I’ve dealt with this can it can be a nightmare! If I were a dentist I’d want danger pay for the fact I have to deal with insurance, too! ;-)

Very true. However, you could definitely then just get a high deductible plan. You’d have the cash plan with the Doc for day-to-day health care, and then the back-up high deductible for worse case scenario. Perhaps an ‘ok’ compromise until we finally collectively wake up in the country and adopt universal health care.

@cmdrsass: It excludes a lot more than major medical. It excludes specialists, ob/gyn, maternity, and it only gets you in the door of the doctors office – you still have to pay for each visit, you still have to pay your copays and your deductible.

One of the specialists I used to see didn’t accept insurance. He shared a small clinic office with a couple of other doctors. It was clean and in good repair but utterly no frills and small. He also charged a fraction of what the other specialist in the area on the traditional model of accepting insurance and having a huge swanky set of offices.

I’ve wondered about this system, supposedly some of these groups limit the number of patients they’ll accept so that you get the kind of access you’re paying for. My question is what happens if one of these patients ends up seriously ill or needing high level of treatment such that they are in to see the doctor once a week or more often? Does that patient get that level of service, is there a contract of some sort, if I pay x per year for full access can my access be trimmed back?

This is a really interesting subject. We have an HSA with a huge deductible. If by doing this, I wonder if I could then turn around and submit the claim for the doctor, thereby almost meeting my deductible with one swoop. Then it would be worth it.

Doctors who opt out of the current insurance-based morass of a health care system in the United States and opt in to a “boutique” or “concierge” model of health care practice only serve to exacerbate an already awful situation.

Put another way, they end up “treating the symptom instead of the disease.”

My doctor sent out notices a year or two ago offering concierge services for $2,500 per person. I don’t think it included any medical care though, the way the OP covers it (but the price differential may be that). I do not recall if it waived the deductible.

What it did offer was 24 hour access and more convenient appointments. Of course, this is exactly like the airlines blocking off wide groupings and classes of seats and then charging you if you want them. Create the disease and sell the cure.

@Bladefist: Umm, so basically Canada and Britain suffer from a shortage of doctors and some stupid bureaucratic policies. Are you trying to suggest that universal health care doesn’t work based on that? Also consider that there are probably at least 50 countries with universal health care.

Don’t get me wrong, despite my views, I’m well aware that there are potential disadvantages to the system. However, this is hardly the smoking gun which I got the impression you were making it out to be.

There is a role for private medicine in Quebec per the report but there is still a universal system of public health care. The two are not unable to coexist by the way, it is not either or. Quebec has had private insurance for patients that covers Cataracts, hip replacement and other elective surgeries since 2005.

My doctor did something about 8 years ago. I had an internist who joined a group of doctors with different specialties that banded together to offer a comprehensive care package — for $6000 a year. That price guaranteed same-day service with visits, tests, X-rays, a lot of outpatient stuff, etc. A few months after he joined I got a letter urging me to join and offering a $1000 discount, then later I got another letter offering a $2000 discount. Later I heard the group broke up but never checked it out for sure.

It would help a lot more if the processes would be streamlined. I moved to another state recently and need to get meds refilled (ones I will likely take the rest of my life). Why do I need to go see a new doctor for that?

Pharmacists and physicians are state licensed. There are definitely licensing reciprocity agreements but I don’t know that a pharmacist in one state can fill a scrip written by a physician from another state.

I can’t imagine this would make a doctor very much – a few hypochondriacs and other people that abuse the plan (“why not send them to my house, I’m paying for it!”) and they’ll lose most of that gain. At least insurance copays keep people from bugging a doctor constantly.

That said, the problem is really the insurance companies. Every year the insurance premium goes up, and so do the copays – but the doc gets less. With some quick math, if the patient copay (goes direct to the doctor) increases, and the insurance costs more, but pays the doctor the same (or less), the insurance company makes more money. Maybe that’s an oversimplification, but if insurers are screwing patients AND doctors, they must be getting mad rich right now…

Those of you who tend wring your hands in fear over universal health care and call it socialism had better be scared. Very scared. If this trend continues, this will push us toward UHC faster than anything. Count on it. Most people can’t afford to pony up 4500 up front just for the privilege of being a patient (this doesn’t pay for the actual healthcare, folks. These people still have to pay for the actual healthcare when they visit the doctor. They also still have to have insurance for anything their doctor doesn’t provide, like ER visits, tests and hospital stays.) I have a feeling this is a trend. I know someone personally that this has happened to. It’s scary. I like my doctor and hope he doesn’t decide to do this.

My doc stopped processing insurance last year. The main organization he was affiliated with wanted him to see patients every X minutes. He said “You know your CEO is one of my clients, right? There’s no way he’ll want that.” He decided he wanted to be in private practice, rather than have to conform to insurance rules that compromise medicine.

So I go, he spends quality time with me when I need to go in, and then submit the bill to my insurance co. when I get home. Anything they don’t cover (since he is by definition, out of network), I submit to my flex spending account.

I know not everyone can afford to go this route, but it’s resulted in far better care for my family overall.

@randomd00d: Internists are technically “generalists” as well, as are geriatricians. Most adults have one or the other as their PCP, and will get most of their care from this physician, unless they have a complicated medical problem,in which case they may have a specialists who manages most of their care.

This type of practice is a “boutique” practice, and is not meant for the hoi polloi, nor is it meant to save you money., It is for busy and wealthy people who are interested in having access to and quality time with their doctor, and to whom the $4500 is a pittance.

Looking at the garbage posted here, its no wonder that the typical American doesnt know whats best for them when it comes to health insurance. Your employer typically pays the bulk of your health insurance premium. You pay only a small amount of it. On top of that – you forget about your deductible. Mine is 2500 dollars. When you go to the doctor, your insurance company is paying a portion of that, and you are convering the rest – up to 2500 dollars a year. Above that, the remainder is split according to whatever your insurance policy specifies. People see $4500 and go nuts. If you didnt have insurance through your company, you would be given much more in salary. In my case, my whole benefits package is actually worth 16% of my salary. Thats 16% more that I could take home if it didnt go toward insurance. I could easily pay the 4500, pay for catastrophic health insurance, pay for my doctor visits, and pocket some change.

24h access *and* home visits? Am I the only one who would scrape together the money just for that? This has got to be one of those too-good-to-be-true… else I’m moving to Maryland. (fwiw, I have lots of health problems. some of which I would kill to see a doctor 24/7 or have a home visit for.)

it’s really not a bad deal for some, especially the elderly since their insurance coverage costs most and often the application is denied. However, I don’t think this $4,500 covers special procedures if you are suffering from severe illness?

the family practice is the general practicioner’s business. he is allowed to implement whatever business model he wants. he does not have a duty to accept any form of insurance at all, nor is he a free clinic. if a mechanic wanted to charge $4500 per customer for a year of work, with 24/7 roadside assistance, everyone would be saying they thought that was a great idea. this is no different. good for the doctors.

I know doctors are having problems, because on my last visit, my doctor went on a 10-minute rant on how insurance surcharges and such are killing doctors. He wants it all to be a flat tax or somesuch. I forget exactly. He went on for a while, and I wanted to be all “Hi, yes. We’re here to talk about me. Fair or not, that’s why I’m paying you a $25 co-pay.”

every year we get a raise and every year that entire raise goes to increased insurance. Now united healthcare is once again raising our insurance another $20 every paycheck, raised our co-pay, and added a 1k deductible which we never had before. Go greed.

We are going to see more of this kinda of concierge service from doctors if the govt. ever gets control of everyone’s healthcare.

Remove 3rd party payers and pay out of pocket for regular doctor visits. The main reason regular visits cost so much out of pocket is that insurance is a scam. My doctor could have a standard office visit charge of $70 and insurance contracts only pay him $18 for the visit. Guess what, he has to make up the loss somewhere, so if you pay cash, you are hosed.

Medical insurance from your employer is like welfare. Everyone else pays most of the cost, so you have the “privilege” of going whenever you feel like it and only pay a small co-pay or percentage of the cost. The cost you pay is getting higher as the insurance system collapses which gets everyone in a tizzy, because they are seeing more of the actual “inflated” cost. If everyone had to pay from their own pocket, prices would come down, due to free market forces. If I don’t like the price of something at one store or service, I go elsewhere and they get my business.

All you should need is catastrophic insurance, for major illesses or hospital visits, etc. Just tack it on to your required car insurance or homeowners insurance.

And free markets ARE hindered when you have insurance or somebody else pay for it.Too many practices have become dependent on the INSURANCE payment like a junkie on crack.I’ve made credit/pay agreements and the office billed my insurance behind my back without my knowledge AFTER the office manager approved a plan for me.The doctor also got mad at me one day when I payed cash for a visit after I explained I didn’t want my insurance billed.One of the CLERKS also didn’t trust me.I’ve always been near AAA credit.And that’s another problem:you have alot of clerk type jobs or clerks that have power and responsibilties they have no business being near.Yes a good clerk might ‘squeeze’ you in for an appointment or bill you for an emergency visit even though you are filling a cancellation.

All based on the false premise somebody else is paying for it with insurance.

The health insurance industry is a FOR PROFIT industry. They make money by taking in money, but not giving it out. The very premise of the industry means they are not looking out for our health as their priority. The industry is just an unnecessary middle man skimming from the pot.

My doctor switched to this kind of service. It completely sucked. I loved her and the service she provided but there is no way i can justify $4500 on top of my regular insurance costs when I only see the doc a couple of times a year. I had to switch medical groups and PCPs and get all my records transferred.

“Sroka, who practices in Crofton, said that after paying salaries and expenses, he makes about $15 to $20 an hour. He said he’s not sure if he can last more than another year or so, working some 80 hours a week to keep up with his bills.”

If he makes $20/hr, and worked 40 hours a week, with a couple weeks off for vacation, he’s making roughly $40,000 a year. Not amazing by any stretch, but very easy to live on it within means. Double that to $80,000 a year and I’m not quite sure what his bills must be.

Scumbag. “It’s about giving quality care.” No, it’s about money. The doctor could alternately–as others have–accept cash only, reduce the administrative staff to a bare minimum, and return the balance to something that offers both the patient and physician something.

I don’t begrudge him making a profit, but let’s call it what it is: gouging your customers.

Well, this is a step in the right direction, although a bit pricey. Health “insurance” should be for emergencies only, unexpected problems … not for routine visits. If I could get insurance to only cover emergency use (at an appropriate rate), and then pay the local doctor completely out of pocket slightly more than what Aetna (my provider) pays them (not what the Dr. bills Aetna, it is already inflated to try to compensate for a broken system), I’d save money and my doctor would make more money. (Anyone who has looked at the EOB’s from office visit claims knows what I am talking about, the doctors are getting screwed by the insurance companies as much as we are.) And even though the plan listed in the article is pricey, it’s still cheaper than I pay for family coverage through Aetna with employer paying the other half.

The problem with our current health insurance model is like if you paid even more for car insurance, but paid a copay to get your oil changed. Then the insurance company covers another small portion of that oil change to the business that did the work, but less than the oil change should cost normally, thus squeezing both the customer and the oil change business. Oh, and you can only go to approved oil change locations, and if there is anything else wrong with your car you need a referral to go to the muffler shop. And if you want a second quote, well, good luck with that one. That sort of plan makes no sense, but it is exactly what he have with health care today. We should be paying a smaller amount to cover emergency care, then cover the rest out of pocket.

I’m sure people with generous employers won’t like this as much, however anyone that has been in the workforce for 10 years or more has seen that the costs of insurance go up every year, benefits get worse, etc (even in cases where the employer steps up and covers a higher percent the benefits get worse drop year after year, and most small businesses get screwed during negotiations setting up employee coverage as well) … so even if your current job pays for everything right now, odds are that will change for the worse down the road.

Although Canada’s health care system isn’t without problems such as appointment waiting-times and priority lists unless you don’t mind paying more in taxes to adopting a Canadian-style system, where the government funds and provides Healthcare this problem will continue in the USA. In the end, the government will spend less and “better” quality service health care will be available to all.

Personally… I think it is time to socialize colleges. Paying through the nose for medical school is too major of a disincentive to be a doctor. There have been a few posts that point out that it isn’t that we need socialized health care, we simply need more doctors!

Also allowing for a degree that sits in the middle between nurse and doctor to see patients that do not actually need much beyond basic care would take a lot of stress of doctors. Popping a joint back in place, and splinting it does not require 12+ years of medical training.

I really hope that the Feds make state and community colleges free, much the way they are in Cali, or Egypt for that matter. One should never have to pay for education, because the results are beneficial to everyone. The more educated society is, the higher the GDP will go.

Now, I am not so much of a socialist that I think ALL education should be socialized. If you want a degree from a better than average institution, like Harvard, then you should be able to pay for it. Sorta like private high schools, not necessary, but there if you have the money.

@LeoSolaris: There are programs out there that will defray the cost of medical school in exchange for years of service in a high-needs area but they are under-utilized because spending six years in the sticks trying to convince country people that they need to exercise and treat their “diabeetus” after already spending an eternity in school becoming a doctor is not appealing to enough medical students.

This is $375 a month for health maintenance. It’d be worthwhile for people with a very high deductibles on their main plan, particularly if it offers a la carte options like only paying for hospitalization and emergency care. This might work for families or people who are chronically ill, but it doesn’t really make a lot of sense for people who don’t have a reason to run off to the doctor all the time (that is, people who are no elderly or who do not have children).

The health care system isn’t really “broken.” Far from perfect? Yes. For what it’s worth, I’m one of the 90% of the 90% (that is to say, one of the 90% of insured Americans, and one of the 90% of that 90% who is very happy with his insurance, and I think I pay a fair price through my employer) [numbers according to Dateline NBC].

y’all want your cake and eat it too. waaaah! waaaaaaaah! I want to be able to get the most professional caring medical service available but god forbid I have to pay anything for it! waaaaaaaaah!!!!!

geebus fR$#@ing xmas already.

1. most doctors get into this business to help others. by the time they’ve been sued 15 times by greedy asshole patients and screwed over by the hospitals and the insurance companies they tend to get a bit jaded. YOU WOULD TOO FOR F$#@’S SAKE

2. a single payer system would be the best answer, but to have the government running it is just plain stupid. the government hasn’t run anything well, ever. you WILL get screwed if you let them run the show. wait and see in nObama’s new socialist experiment (as if the USSR hadn’t already shown the world that particular philosophy just doesn’t work!)

3. law suits against doctors are probably 90% plus frivolous. that’s an accurate number and probably actually conservative. until we find a way to stop this abuse of our right to sue anyone we please, health care will continue to cost an arm and a leg, and your MD will continue to fear and therefore ultimately hate you. do you like to know that your MD actually fears and hates you? if he/she has been sued by their patients, trust me, they fear and hate you. all of you. how would you feel, suffering for years to learn how to take care of sick and suffering patients, devoting your LIFE to attempting to alleviate suffering, then BAM!! getting sued by some asshole who just wants to take away your Mercedes Benz ‘cuz they think you haven’t earned it. Or they just don’t care and want what you have because the law and some f$#@ing stupid jury composed of housewives and jackasses are more swayed by the plaintiff’s lawyer.

there are answers to this complex problem, but it should be the MDs, first and foremost, who help to shape the new system we design, NOT the lawyers, politicians, government. it’s the MDs who have historically actually been the ‘advocate’ of their patients, NOT the f$#@ing lawyers, politicians, government.

people, for FUCK’S SAKE, wake up and smell the coffee. this country, once great, can still be fixed if only we will begin to adopt new systems that WORK, that are constantly reviewed and tweaked to excel. NO reason for this mess we find ourselves in, except common human (CHOSEN) ignorance, greed, selfishness, and laziness.

1) The Post Office consistently runs better than FedEx and UPS, and has home and weekend delivery and pickup, all for the price of a 40-cent stamp. And it turns a profit. You tell me how that’s the government “not running anything well, ever.”

2) The VA hospital system – administered and run by the government – is consistently better-rated than most area for-profit hospitals.

3) Social Security, despite Republican misinformation about its “imminent demise”, is the best-run social insurance program in the world, with less overhead and expenses and better administration than any private firm in the country.

Government-run healthcare is apparently so awful, after all, that every single member of Congress including John McCain has opted for it for their own healthcare needs. You might want to ask your guy, or his supporters, why he thinks that a public healthcare system would be so bad for everyone but him. It was, after all, at a government-run hospital that he was patched up after his POW experience.

An insurance model simply can’t work for healthcare. It works for houses because not everybody’s house burns down. But everybody needs healthcare. Insurance can’t work.

As a family physician practicing for 30 years I have seen and done it all. From delivering babies in the patient’s home unexpectedly to making house calls to a dying elderly patient. The overhead of dealing with insurance companies and our present “Nationalized Healthcare” called Medicare has made the family physician’s profit margin go to less than 15% if you work for just 45 hours per week. Medicare has FIXED the prices for all physician’s services since 1984. Since 1984 physicians have not been allowed to bill anything extra for the time that they spend with the patient. If I give extra time to the patient I must document all sorts of signs and symptoms unnecessarily in order to “possibly” be paid what the government decides what I should pay. This is why we are going to a prepaid formula to avoid being sent to jail for billing more than medicare will allow us to bill you. Presently we are only allowed to charge $3 to draw your blood and fill out all the paperwork so that the lab can bill medicare. This is why most of us do not want to draw blood anymore. If we charge more for the personalized service we can be sent to jail for 6 months for each offence under the medicare program. Therefore we are now drawing the line in the sand. I can make it if my patients pay only $700 per year extra in order to keep me in business. I would rather charge by the time that I spend with them like I did before 1984 and the cost would be less but you government and insurance companies demand that we work for them and not you.

Back in the good ole’ days, doctor’s did house calls, and did not charge an arm and a leg for a regular appointment or hospital stay. As the years have gone by, everyone has gotten in the act! Physicians, the drug companies, the medical insurance companies, the hospitals, etc…. and they have made medical care into a “For Profit” business, with no real regard for the patients. Filling their quota, asking for insurance before any treatment is done; all this is BS! Doctor’s make alot of money off of us pions!!!!! Living in luxury!! They paid alot for school, and they want to make that money back and then some!! I think this is all a conspiracy!!! Enough said!

Health services consist of more than a visit to the primary doctor’s office. In this model, you first pay an annual fee; then when you call the doctor, he or she might charge you a consultation fee for talking on the phone; then you go to the office, there is a flat fee for “seeing” the doctor. How about you need lab, it usually goes to outside private lab. That can easily add up to several hundred dollars (for example, for a cash pay patient a real lipid panel, not the in-house finger stick for cholesterol, is $150 to $200); if you are going to have any outsider procedures (let’s say a CT scan, it is close to thousands); how about you need a specialist, then you are an uninsured patient to that specialist doctor. By the way if you have kids, you had better pray that none of them break any bones or have any accidence.
There are a lot of other charges from outside of your primary doctor’s office when you receive health services. In this model, the patient would be left in the cold for all this “other providers’ charges”. Even if you have other insurances, they might not pay for the orders or referral from out of network providers.
I guess this model might work, if the patient is young and lives in a safety bubble. Also, if there are different disciplines of doctors to form a small group. In that case, we just create another private HMO. Was that how the Blue Cross Blue Shield started many years ago, a group of doctors got together and form a health insurance company. The bottom line is doctors want to make more money like everyone else. Doctors have their family to feed too. Do you honestly think the doctor worry about helping every patient? Think about if you have financial difficulty in the middle of year and cannot pay the flat visit fee, will the doctor continue to see you on a credit. You can forget about it.
The core issue is all we Americans need to push some health insurance reform to cap or regulate health insurance industry. The problem is the health insurance company, not the patients or the doctors. Between patients, doctors, and insurance companies, insurance company is the only one making tons of money. US Health Insurance Company is the most profitable industry in the world. Based on some statistics, one of the health insurance companies even makes 200% profits in one year. We all know that beside insurance premium from employee and employer, there are co-insurance, deductible, and co-pay. Did you ever wonder where all the premiums have gone, how about CEOÃ¢Â€Â™s bonus! Don’t you think there is something wrong?

I know docs that do this model. They really are available 24/7. Usually its 2 docs covering the practice, so they can have days off. There is also FAR less patients…thats what lets them have more time. It allows them to give the attention each patient needs, the time and availability the doctor wants to give, but cant at just the insurance rates. IMO you get what you pay for (but not specialist coverage). Downside: it kinda screws regular/poor people. Usually they donate about 1 out of 25-50 spots to people with no health insurance (at least the ones I know).

I know of FPs that had to quit their job and wokr for pharma cause their practices were losing money…or they were working 60 hr weeks for 60 grand…might as well work a less stressful job.

And its true, this only covers your family practice visit. The upside is, you will be referred out less since the doc has more time to manage your problems. But you have to find a good one. And it still wont cover X-rays, consults etc…but a lot of the docs have deals for “routine” stuff with the labs..ie your membership might cover part of chest X-rays and lab…but definintly not chemo, MRIs, ED visits…

I’m an American currently living overseas. I have health insurance from an European company and my annual premium is approximately $4000. For this amount I get worldwide coverage, medical evacuation, prompt payments with no hassles and a yearly coverage of $1.5 million. Overall, I think I get a better deal than I had when I was living in the States and had coverage from an American insurance company.

As a doctor who works in an underserved urban community, I find the whole “boutique” concept to be utter greed.

Many of my classmates and peers have shunned insurance/Medicare/Medicaid altogether, choosing instead to practice in wealthy areas where they can charge high fees for their services. As a result, they end up serving <1% of the population, and an even smaller proportion of the population who actually NEED their care (sometimes desperately). Sorry, that doesn’t sit well with me, as it runs directly opposite to why I chose this profession.

True, practicing medicine with third-party payment is frustrating, but it CAN be done (and even done efficiently, with some creativity), and it even pays a living wage. I may not be earning the salary of a Beverly Hills dermatologist, but I’m able to support myself. Moreover, I’m providing good care to people who need it and I thrive on the therapeutic interaction with my patients– that’s why I’m a doctor.